House-call hopes;

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A Medicare pilot program aims to cut medical costs and visits to the hospital

The Orange County Register

MISSION VIEJO, CA — House calls in America died out like tonics and leeches.

But the federal government, with the help of a Southern California health- care company, has begun testing a program that could save tax dollars and improve patient care by tweaking that old-fashioned tradition ‘ putting physicians on doorsteps with black medical bags that also carry laptops.

Wadia Adam, 71, of Mission Viejo is part of the experiment.

On a recent Sunday morning, she awoke with labored breathing, a symptom of her congestive heart failure and a sure sign of yet another visit to the emergency room.

But as her husband, Abdu, went to call an ambulance, he spotted her doctor’s cell-phone number.

Thirty minutes later, Dr. Joomo Yang arrived at Adam’s bedside.

He gave Adam a shot to clear her lungs of fluid and ordered a chest X-ray. Then he sipped a cup of tea brewed by her husband.

The visit spared Adam a long wait in the emergency room and saved Medicare a big hospital bill.

Adam is one of about 1,500 Orange County patients eligible for Medicare’s program to determine whether around-the-clock home visits from doctors can offer the kind of preventive care that keeps health-care costs down. The relatively new model has already proved successful for private insurance companies.

“We want to see the quality of care improve, and we want to see a cost savings,” said Jeff Flick, regional administrator for Medicare.

Patient advocates praised the voluntary program but also cautioned that patients should receive the care they need, even if it’s expensive.

“If the appropriate treatment is to keep them out of the hospital, that’s fine,” said Jamie Court, president of the Foundation for Taxpayer and Consumer Rights in Santa Monica. But he added that finance should take a back seat to health.

“The incentive should be to treat the person.”

It’s hard to tally how government spending on health care affects corporate bottom lines. But if programs such as house calls substantially reduce costs for the government and private insurers, then taxpayers, businesses and employees might eventually benefit.

The program is aimed squarely at one of the most expensive segments of the vast Medicare system. Among Medicare recipients, the sickest, frailest 5 percent account for 43 percent of costs or about $142 billion each year.

In October, Medicare launched the three-year home-visit program for 15,000 people in California, Texas and Florida. The federal government selected participants who were hospitalized at least twice last year. Their medical records will be compared with a control group to gauge cost savings and quality of treatment.

The company behind the home visits is Care Level Management of Calabasas. Company executives say frequent visits with patients allow doctors to catch subtle changes and treat illnesses before patients deteriorate. Savings for private insurance companies such as Blue Cross of California have averaged 30 percent.

Medicare has struck a more modest deal to test the concept. Care Level will not receive any payment unless the program produces a 5 percent savings for Medicare as well as enough savings to cover the company’s monthly expenses. Doctors start at $165,000 a year.

“I always joke a little bit that we don’t do appendectomies on the kitchen table. We do have some limitations,” said Dr. Henri Becker, co-founder and chief medical officer of Care Level. “But because we are treating chronic illnesses, there can be an opportunity to treat it before it gets too severe.”

For Dr. Yang, even a phone call can accomplish that goal.

On a Thursday afternoon, he called a patient to check up on her. She said she felt fine but mentioned a swollen stomach. Yang directed her to have the fluid drained at the hospital the next day by a radiologist.

Yang said that had her pain worsened over the weekend she would have likely had to be admitted to the hospital to await the procedure on a Monday morning.

According to the American Academy of Home Care Physicians, about 2 million home visits were made last year, a tiny number compared with the estimated 824 million visits to doctors offices in 2000.

But proponents say there are nowhere near enough doctors who make house calls to cover demand from patients who lack mobility or transportation.

Besides convenience, house calls offer an important connection that’s harder to achieve in a doctor’s office.

When Yang returned to the Adams’ home a few days after her breathing scare, Wadia Adam sat on her tapestry couch, next to her knitting needles and remote control.

Yang knelt beside her to administer a vitamin B12 shot prescribed by her cardiologist. He consulted his Palm Pilot to see her list of medications. He brought a video for her on the Medicare program.

When her husband mentioned his service in the Korean War, Yang noted that he’s from Korea.

Yang sees no more than eight patients a day. Before leaving private practice this fall, he might have treated as many as 30.

“You see their living conditions,” said Yang, a 39-year-old San Clemente resident. “Patients open up much more because it’s their own home. We can look at their pill bottles.”

Patients often feel more willing to share information while relaxed at home rather than in a sterile office.

“You go in, you get dehumanized by taking all your clothes off. You have maybe five minutes with the doctor,” said Kristine Yahn, a registered nurse and the executive director of Californians for Patient Care, a nonprofit advocacy group in Sacramento. “It’s hard to feel like you’ve got time to really ask all your questions or even remember what they are because you’re trying to keep covered in the gown.”

Adam, who wore a house dress for her exam, said she can’t believe Dr. Yang is for real.

“This doctor is the best, honestly,” Adam said. “I’m dying Sunday. I couldn’t breathe. He came right away. I don’t like to go to the hospital.”

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